Francesca Gaino1,2, Philippe Gorphe3, Vincent Vander Poorten4,5, F Christopher Holsinger6, Renan B Lira7, Umamaheswar Duvvuri8, Renaud Garrel9, Sebastien Van Der Vorst10, Giovanni Cristalli11, Fabio Ferreli1,2, Armando De Virgilio1,2, Caterina Giannitto12, Emanuela Morenghi13, Giovanni Colombo1,2, Luca Malvezzi1,2, Giuseppe Spriano1,2, Giuseppe Mercante1,2. 1. Humanitas University, Department of Biomedical Sciences, Milan, Italy. 2. Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy. 3. Department of Head and Neck Oncology, Institute Gustave Roussy, University Paris-Saclay, Villejuif, France. 4. Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium. 5. Department of Oncology - Section Head and Neck Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium. 6. Division of Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA. 7. Department of Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil; Robotic Surgery Program, Hospital Israelita Albert Einstein, São Paulo, Brazil. 8. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 9. Département ORL CCF et CMF, CHU de Montpellier, Montpellier, France. 10. Department of Head and Neck Surgery, Université catholique de Louvain, CHU UCL Namur-site Godinne, Yvoir, Belgium. 11. Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Padua, Italy. 12. Diagnostic Radiology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy. 13. Biostatistics Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy.
Abstract
BACKGROUND: Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a "Pharyngoscore" to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. METHODS: Three-hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh-Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. RESULTS: Sixty-five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. CONCLUSIONS: The Pharyngoscore is a promising tool for calculating DOE probability before TORS.
BACKGROUND: Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a "Pharyngoscore" to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. METHODS: Three-hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh-Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. RESULTS: Sixty-five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. CONCLUSIONS: The Pharyngoscore is a promising tool for calculating DOE probability before TORS.